Separately, pizza and beer put your BG on their own individual rollercoasters. Pizza is high carb but loaded with fat, so most of the carbs hit your blood stream several hours after consumption. Beer is an alcoholic beverage, which typically acts to lower BG, but unless you choose a lite beer option (not for me, I like flavor!) you also have some carbs upfront with beer that you have to account for. So combine these two rollercoasters and you get this super, mega BG rollercoaster that lasts for several hours. If I didn't like pizza and beer as much as I do, I wouldn't bother trying to conquer this challenge. But I fully believe in the idea that a diabetic can eat (and drink) anything they want, but you need to do some trial and error with bolusing first.
I believe in the beginning of my search for the pizza and beer super bolus, I would generally do a normal bolus for the beer (which is roughly 2 units for me), then do a dual bolus on the pizza with 40% normal and 60% square over 3 hours. What I found with this combination is that I had way too much insulin upfront, resulting in correcting a low only to bounce up from the delayed carbs several hours later. So I tried tweaking the time of the square bolus to 6 hours, 4 hours, 3 hours, then 2 hours. I was still crashing long before the delayed carbs were hitting me.
Well, Monday, perhaps out of pure genius but more laziness, I decided to include my beer bolus in my 40/60 dual bolus. My total insulin increased, but the amount dedicated to the pizza was more on the square bolus rather than the normal. This resulted in cruising around 100 mg/dL for 3 hours (the amount of time on my square bolus). I thought I had finally conqured it. *insert choir singing "Hallelujiah!* In fact, I was little worried because when I went to bed I was at 95 mg/dL with 2.5 units left on board. I was fully expecting to be awoken by Constance with a low alarm.
However, I ended up seeing those delayed carbs 3 hours later (6 hours post-pizza consumption) when I peaked around 189 mg/dL at midnight and stayed there. I have heard from other diabetic pizza-eaters (sounds like an oxymoron) that after the square bolus that they bolus or do a temp basal for 10% of the total carb amount. Had I done that, my correction factor would have lined up perfectly with 10% of my total carbs.
So now I have a new game plan. The pizza and beer super bolus is very involved and requires lots of time and tweaking to figure. To be honest, if I didn't have Constance I don't think I would have been this adamant about finding the right timing and amount in insulin. Here's the plan:
- Count total number of carbs from pizza and beer.
- Do a dual bolus with 40% normal and 60% square over 3 hours.
- After the 3 hour square bolus, set a temp basal for 3 hours for 10% of the total carb amount in Step 1. I suppose a square bolus would do the same, too.
- Test, confirm, test, confirm.